Reboot 2012: Returning a High School Basketball Player To Competition After Bilateral Radius Fractures

This is a re-post from 2012. It is an overview of Nolan Berry’s return to competition after fracturing the radial head in both his R and L arms in mid-November of his senior year. He not only returned to play; he helped lead his team to the Missouri Class 5 state championship game. Nolan is still playing basketball and just finished his first year as a professional, playing for the Lugano Tigers in Switzerland. This story shows the power of the seamless integration of rehabilitation and athletic development. It also shows some things that I probably wouldn’t do now — but that’s what we do: we evolve and learn.

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Tonight Nolan Berry will play on the DeSmet home court for the first time this season. A few weeks ago, I wasn't sure he would play any of his senior year.

Tuesday November 20, 2012, I received the following text from Meg Berry, Nolan's mom:

"Big Bird broke both of his arms in practice last night. So sad."

My heart sank. The kid was in the best shape of his life. Just the week before, DeSmet coach Kevin Poelker had texted me to say that Nolan was leading his team in practice and looking "stronger than ever." We had successfully rehabbed a bad ankle sprain back in June and a dislocated patella in late July and August; gotten him to personal bests in all of his lifts and up to 226 lbs. He was fit, strong and ready.

The fractures were at the radial heads. Two in the left arm and one in the right. Ugh. The elbow is such a complex joint. So hard to get full range of motion back after being immobilized for long periods. He'd be in bilateral, full arm casts for weeks. Not a fun prospect for an 18 y.o. boy or his mom.

But wait. He wasn't casted; just placed in splints for 1 week and told he would begin therapy the next week. Maybe there was hope. I asked my friend Ed Ryan, the ATC for the USA Women's Olympic Basketball Team, what the rehab timeline might be as I'd never worked with this particular injury before. He said 6 weeks if everything went well and there were no complicating factors.

Six weeks and three days later, Nolan Berry was cleared by his MD for full participation in practice and games. He scored 11 points and had 8 rebounds in his first game back on January 5th. The story of his rehab and recovery are unique, if not remarkable. I am proud to say I played a part in his return to the court and would like to share our journey (with Nolan's permission, of course) over the next week or so.

Nolan's rehab was successful and quick because of the following:

1. The fractures did not require surgery, pins or long term immobilization.

2. He worked with an upper extremity therapy specialist for rehab proper. She focused on range of motion and function of the elbow, hand and wrist. For him to play basketball in the future, full range of motion at the wrist and elbow were an absolute necessity.

3. His home exercise program and work outside of therapy were guided by me, a physical therapist who specializes in returning athletes to sport--and one who understands the demands of basketball .I was not going to let him have more than 24 hours without structured exercise in the first few weeks. I would keep him focused on returning to play and use the basketball as much as possible, as soon as possible.

4. Nolan had a physical literacy and athletic development training base of 4 years with me. We had a vast library of movement from which to rebuild his body and confidence, while he was doing traditional upper extremity therapy. This would be key if he was to safely return to full strength during this season.

I knew exactly what his previous abilities were and exactly how much I had to emphasize the importance of his compliance with therapy for him to return to 100% function. 18 y.o. boys are not exactly known for their attention to detail. But I had the ear and trust of his mother and his coach, so between the three of us, we could hold him accountable. After 4 years of working together, this was definitely going to be our biggest and most interesting physical, emotional and psychological challenge.

Before I get into some of the details of our work, I thought it would be fun for people to see a bit of what Nolan did over the last four years; how much he has changed physically and some of the not-so-glamorous things he has done to become a durable big guy. Other than injuries from collisions--ankle sprains and the patellar dislocation--Nolan has not suffered any of the nagging overuse issues (knees, feet, back) that have plagued DeSmet big guys in the past.

Link to video showing Nolan over 4 years of high school.

My focus has not been sport specific--on building a basketball player. It has been on building a durable, physically competent athlete with a movement vocabulary that will prepare him for the collegiate level and beyond. Like all young athletes, Nolan needed basic infrastructure: mobility, strength, body awareness and control. He had the basketball skill and IQ. My job was to help him build the physical foundation and confidence to express his basketball skills.

Stay tuned for Part 2: The First Three Weeks